Jovin Ion S, Ebisu Keita A, Oprea Adriana D, Brandt Cynthia A, Natale Donna, Finta Laurie A, Dziura James, Wackers Frans J
Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Department of Medicine, Virginia Commonwealth University, 1201 Broad Rock Boulevard 111 J, Richmond, VA, 23249, USA.
J Nucl Cardiol. 2016 Aug;23(4):773-9. doi: 10.1007/s12350-015-0268-3. Epub 2015 Sep 4.
Clopidogrel is a platelet adenosine receptor antagonist which can influence coronary vascular tone and thus can potentially interfere with myocardial perfusion imaging. We investigated whether clopidogrel can hamper the diagnosis of ischemia in patients undergoing myocardial perfusion testing.
Data from a database of 6349 myocardial perfusion stress tests were analyzed. Using a propensity analysis, patients who were taking clopidogrel were compared with patients not taking clopidogrel for the presence of reversible perfusion defects on myocardial single-photon emission computed tomography scans.
Of the 6349 tests, the stress technique was adenosine in 2713 patients and exercise in 3636. At the time of the stress test, 277 (4.3%) of the patients were taking clopidogrel. The odds ratio (OR) for patients taking clopidogrel to have a reversible perfusion defect was 2.75 (95% confidence interval [CI] 2.09-3.62; P < .01). After adjusting for the propensity to take clopidogrel, the OR was 1.06 (CI 0.76-1.49; P = .73) for patients undergoing adenosine stress tests and 1.60 (CI 0.85-3.00; P = .14) for patients undergoing exercise stress tests.
We found no evidence that the use of clopidogrel decreases the likelihood of ischemia on adenosine or exercise stress myocardial perfusion scans.
氯吡格雷是一种血小板腺苷受体拮抗剂，可影响冠状动脉血管张力，因此可能干扰心肌灌注成像。我们研究了氯吡格雷是否会妨碍接受心肌灌注测试患者的缺血诊断。
分析了来自6349例心肌灌注负荷试验数据库的数据。采用倾向分析，比较服用氯吡格雷的患者与未服用氯吡格雷的患者在心肌单光子发射计算机断层扫描上是否存在可逆性灌注缺损。
在6349例检查中，2713例患者采用腺苷负荷技术，3636例患者采用运动负荷技术。在负荷试验时，277例（4.3%）患者正在服用氯吡格雷。服用氯吡格雷的患者出现可逆性灌注缺损的比值比（OR）为2.75（95%置信区间[CI]2.09 - 3.62；P <.01）。在调整服用氯吡格雷的倾向后，接受腺苷负荷试验的患者OR为1.06（CI 0.76 - 1.49；P =.73），接受运动负荷试验的患者OR为1.60（CI 0.85 - 3.00；P =.14）。
我们没有发现证据表明使用氯吡格雷会降低腺苷或运动负荷心肌灌注扫描时缺血的可能性。
